台灣出血型腦中風急性期中醫證型之研究

目的　中醫的特點是整體觀和辨證論治，以辨證來決定治療方針，所以治療疾病的成敗與證型的判定有密切的關係。因此本研究的目的是探討出血型腦中風急性期的中醫證型。方法　蒐集148位中部某醫學中心由急診入院，經頭部電腦斷層或磁振造影檢查及神經科專科醫師診斷確定為出血型腦中風急性期病患，分別填寫腦中風登記表、生活功能獨立執行測量表、Modified Rankin Scale (MRS)、美國國家衛生研究院中風評量表(national institute of neurological disorders and stroke, NIHSS)、巴氏量表。另外，由兩位資深中醫師利用望、聞、問、切等四診診察，取得一致性後填寫中風病辨證診斷量表，以上工作都在腦中風發病開始7天之內完成。結果　在148位中有一個證型，以風證最多141位(95.27%)，其次痰證60位(40.54%)、火熱證43位(29.05)、血瘀證39位(26.35%)、氣虛證7位(4.73%)而最少為陰虛陽亢證3位(2.03%)。同時有兩個證型以風－痰證59位(39.86%)最多，其次為風－火熱證40位(27.03%)、風－血瘀證38位(25.68%)、火熱－痰證19位(12.84%)，痰－陰虛陽亢證和氣虛－陰虛陽亢各1位(0.68%)最少。有火熱證和有痰證患者的MRS，以及有氣虛證患者的NIHSS較無那些證型患者較輕。風證75.18%，火熱證86.05%，痰證71.67%，血瘀證79.49%，氣虛證85.71%，陰虛陽亢證100%有高血壓。另外，死亡的有8人(5.4%)，而無法歸類為風、痰、火熱、血瘀、氣虛和陰虛陽亢等證型的3人中有2人死亡(66.7%)。結論　台灣出血型腦中風急性期的中醫證型以風證、痰證、火熱熱和血瘀證為主。風、痰、火熱和血瘀是出血型腦中風的主要臨床表現。出血型腦中風患者火熱證比非火熱證，痰證比非痰證，氣虛證比非氣虛證的臨床表現較不嚴重。證型與高血壓有高度關係，而無法歸類為風、痰、火熱、血瘀、氣虛和陰虛陽亢等證型的患者預後較差。

關鍵字

出血型腦中風急性期；中醫證型

並列摘要

Purpose. Chinese Medicine (CM) uses pattern identification to determine the method of treatment. The effective treatment is closely related to the Chinese Medicine pattern (CMP) identification. Therefore, the purpose of the present study is to investigate the CMP in patients with acute stage hemorrhagic-type stroke. Methods. We collected 148 acute stage hemorrhagic-type stroke patients from the emergency department of a medical center in central Taiwan. All patients were studied within 7 days after stroke onset. Hemorrhagic-type stroke was confirmed by cranial computer tomography or by magnet resonance image, and a neurological specialist. Patient data was retrieved from Stroke Registry charts, Functional Independence measurements, Modified Rankin Scale (MRS), national institute of neurological disorders and stroke (NIHSS), and Barthel Index. In addition, CMP data of the patients were assessed by two CM doctors who used the four examinations including inspection, listening and smelling, inquiry and palpitation. Results. A total of 148 acute stage hemorrhagic-type stroke patients were studied in the present study. In patients with one CMP, the Wind pattern (WP) 141 (95.27%) was most prevalent, followed by Phlegm pattern (PP) 60 (40.54%), Fire-hot pattern (FHP) 43 (29.05%), Blood-stasis pattern (BSP) 39 (26.35%), Qi-vacuity pattern (QVP) 7 (4.73%), Yin-Vacuity and Yang-hyperactivity pattern (YV-YHP) 3 (2.03%). In patients with two CMP, Wind-Phegm pattern most prevalent 59 (39.86%), followed by Wind-Fire-hot pattern 40 (27.03%), Wind-Blood-stasis pattern 38 (25.68%), Fire-hot-Phegm pattern 19 (12.84%). Phegm-Yin-vacuity and Yang-hyperactivity pattern 1 (0.68%), Qi-vacuity-Yin-vacuity and Yang-hyperactivity pattern 1 (0.68%). The MRS score was lower in patients with FHP than those without FHP. Similarly, patients with PP had lower MRS score than those without PP. The NIHSS score was lower in patients with QVP than those without QVP. Hypertension in patients with WP was 75.18%, FHP was 86.05%, PP was 71.67%, BSP was 79.49%, QVP was 85.17%, and YV and YHP was 100%. A total of 8 patients (5.4%) die in 148 acute stage hemorrhagic-type stroke patients. 2 patients (66.7%) die in 3 patients who without WP, PP, FHP, BSP, QVP or YV and YHP. Conclusions. CMP in patients with acute stage hemorrhagic-type stroke comprises WP, PP, FHP and BSP. The main clinical manifestations of acute stage hemorrhagic-type stroke are Wind, Phegm, Firehot and blood stasis. The clinical manifestations were milder in patients with the FHP, PP and QVP than in patients without FHP, PP and QVP. The CMP is closely related to the CMP of hypertension. The prognosis is poor in acute stage hemorrhagic-type patients that did not have comprising WP, PP, FHP, BSP, QVP or YV and YHP.

並列關鍵字

acute stage hemorrhagic-type stroke ； Chinese Medicine Pattern

國際替代計量

台灣出血型腦中風急性期中醫證型之研究

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